Chapter 6: You Don't Want to Ruin Your Career, Do You?
David, suddenly put on the spot by House, wasn't surprised at all.
He organized his thoughts and began:
"Pork is indeed a common food in the American diet.
But if pork isn't cooked thoroughly—say, to an internal temperature of at least 145 degrees—the tapeworm larvae that may be present can enter the digestive system.
Their scolexes have tiny hooks that attach to the intestinal wall, where they parasitize, grow, and reproduce..."
Before David could finish, Chase shook his head and interrupted:
"No, hold on. What you're describing is wrong.
You said it yourself—they enter the digestive system.
But Rebecca's symptoms are neurological, not gastrointestinal. You're not seriously suggesting that an intestinal parasite affects the brain, are you?"
As soon as he said this, everyone's eyes turned to David, waiting to see how he'd explain this away.
David smiled slightly, unfazed by Chase's challenge. Instead, he continued confidently:
"That's exactly why this isn't a typical case. A single tapeworm can lay twenty to thirty thousand eggs per day.
Normally, these eggs leave the body through the digestive tract, but there are always stragglers left behind.
Unlike mature larvae, these unhatched eggs are small enough to penetrate the intestinal wall and enter the bloodstream, where they can travel throughout the entire body.
As long as the eggs remain viable, the human immune system doesn't reject them—it actually recognizes them as part of the host.
The larvae hatched from these eggs can evade immune surveillance by secreting specialized proteins that mimic human tissue markers.
This allows tapeworms to survive virtually anywhere in the human body, including the brain, though it's rare.
That's neurocysticercosis—tapeworm cysts in the central nervous system.
The cysts increase intracranial pressure, which causes the clinical presentation: headaches, vomiting, aphasia, seizures—everything Rebecca's been experiencing."
After listening to David's explanation, Foreman chuckled, glanced at Chase, and said with deliberate emphasis:
"The intern's actually got some knowledge. Now I'll believe you actually handled that clinic patient.
But what's your plan now? Call in a veterinarian to deworm her?"
David shook his head:
"Nothing that complicated. We just need her to take albendazole—it's a highly effective, broad-spectrum antiparasitic with low toxicity—before the tapeworm dies naturally."
Cameron, who'd been listening intently, suddenly asked:
"What happens if the tapeworm is already dying?"
David spread his hands:
"Then we've got a problem. Once the tapeworm dies, its corpse loses the ability to fool the immune system.
The body's defenses kick back in and try to attack the foreign tissue in the brain.
The inflammatory response—the fever, the swelling—would cause catastrophic brain damage."
Clap, clap, clap!
A round of applause echoed in the hallway.
It was House.
"Not bad, kid. Solid analysis. I'll handle the fallout from your clinic adventure.
Cameron, go inform Rebecca of the diagnosis and get her started on treatment."
Clinic?
Chase's interest was immediately piqued. So there had been an issue with David's clinic patient.
He glanced at Foreman, whose expression was darkening, with a knowing half-smile—as if to say he'd won after all.
Then he asked casually:
"What happened in clinic? Did David screw something up?"
House chuckled at the question, his expression mischievous:
"The diagnosis wasn't the problem. He got it right, and then some.
He also informed the patient that his wife was cheating on him. Guy's filing a complaint with Cuddy right now."
The smile froze on Chase's face. He grimaced and handed a twenty-dollar bill to the grinning Foreman.
He'd never expected that House's mention of a "clinic problem" had nothing to do with diagnostic ability, but with the patient's personal life.
Turns out David hadn't done poorly—he'd done too well.
Reading between the lines of House's comment, David's talents were wasted on medicine—he should've been a private investigator.
Why hadn't Chase noticed this intern had such instincts before?
Otherwise he wouldn't have lost the bet.
Chase shook his head, dismissing the thought.
Just then, Cameron—who'd gone to inform Rebecca of the diagnosis—emerged from the room with a troubled expression.
House, sensing something wrong, immediately asked:
"What happened?"
Cameron hesitated for a moment but told the truth:
"She doesn't trust us anymore. She's refusing treatment. Says she'd rather just... let it happen."
House was momentarily stunned. After pacing back and forth several times, he finally made up his mind.
He told everyone, "I'll talk to her," and pushed through the door into the patient's room.
He wanted to use his own experiences—his own struggles with pain and loss—to convince Rebecca to respect life and not give up.
Foreman watched House's retreating back and asked David:
"Kid, you seem to have all the answers. If House can't convince her, what's your plan?"
David looked at Rebecca through the glass partition, his eyes filled with genuine empathy.
Because he could completely understand Rebecca's current state of mind.
He'd experienced situations like this more than once himself.
So he spoke almost as his former self—as a terminal cancer patient:
"She doesn't really want to die. She just doesn't trust us anymore. She's terrified that hope will turn into despair again, afraid of being tortured by treatment that doesn't work.
The physical and emotional suffering that causes isn't any easier than just... letting go.
So what we actually need to do is make her believe there's a tapeworm. Give her proof she can trust."
Foreman scoffed. This intern was full of idealistic theories.
But he couldn't provide the most crucial element—the method.
If House couldn't convince her, Foreman would still have to find a solution:
"You're wrong. We don't need her to believe anything. All we need is a court order.
We tell the judge her mental capacity is compromised by the disease and she can't make informed decisions. The court will back our petition.
Then we can force the treatment."
Cameron's eyes lit up in agreement:
"Exactly. In a life-or-death situation like this, we just argue that the disease has rendered her temporarily incompetent.
I'm sure she'll understand and thank us later."
Listening to the increasingly absurd suggestions from House's three fellows, David couldn't help but roll his eyes.
Foreman caught that eye roll immediately, and whatever goodwill he'd developed toward David for winning him money vanished instantly.
His gaze locked onto David:
"What? You still think you can somehow make her believe she has brain parasites?
Then what's your brilliant solution? Or better yet—how exactly will you prove it to her?"
Seeing Foreman challenge David again, Cameron frowned and tried to intervene:
"Foreman, he's just an intern. It's normal if he doesn't have all the answers."
Foreman sneered and launched into a lecture:
"Not having answers is fine. But dismissing our professional opinions with an eye roll? That's not fine.
Don't think that getting lucky once or twice makes you House's equal.
Remember—you're still an intern, not a licensed attending physician!
Like I said before, luck runs out eventually.
You're not Gregory House. In this profession, one major mistake and you're blacklisted from every teaching hospital in the country.
If you want to survive in medicine, you need to learn to respect the experience of your seniors.
You don't want your career destroyed before it even starts, do you?"
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